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As the impact of the coronavirus grows, we would like to provide some important updates and to assure you that you are our top priority. During the public health emergency, we have made proactive outreach attempts and updated our online directories with the information received. However many providers did not respond and we have provided the results of our best efforts. If you need dental, eye care or hearing services and cannot locate a provider, please call us and we will assist you in finding a provider that is seeing patients during this public health emergency. Click here to learn more.
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Providers Credentialing

Application

Prospective providers must submit a Provider Application, which contains information on the provider’s education, training, professional background, licensure, DEA certificate (if applicable), evidence of Diagnostic Pharmaceutical Agent Certification, and/or Therapeutic Pharmaceutical Agent Certification.

  •   Licensing
    Providers must also submit a current license, which we verify with the State Board of Optometry or the American Board of Ophthalmology and/or the American Medical Association.
  •   Insurance
    All participating providers must have professional liability insurance with minimum limits of $1 million/$3 million.

Credentialing

Once we receive the competed application and required documents, it is submitted to the Avesis Credentialing Committee for review. Upon approval, the provider will receive an executed Provider Agreement and information about our program in general and our specific plans. Our Provider Manual may be downloaded at any time here.


Re-credentialing

Every three years, providers must submit an updated application, attestation, and current credentialing documents. The provider’s performance will be evaluated, with a review of any quality of care complaints. Quality of Care Management evaluates each practice and monitors the following:

  • Quality of care
  • Efficiency of care
  • Member satisfaction
  • Fulfillment of administrative requirement
  • Compliance with clinical standards

Provider Credentialing Forms

Re-credentialing Applications Disclosure of Ownership Forms